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Journal of Community Health

, Volume 34, Issue 4, pp 321–327 | Cite as

Asthma 1-2-3: A Low Literacy Multimedia Tool to Educate African American Adults About Asthma

  • Rina M. Sobel
  • Michael K. Paasche-Orlow
  • Katherine R. Waite
  • Sarah S. Rittner
  • Elizabeth A. H. Wilson
  • Michael S. Wolf
Original Paper

Abstract

Asthma 1-2-3 is a newly-developed low-literacy multimedia education tool designed to promote asthma self-care concepts among African American adults. An expert panel (n = 10) informed content development for the tool. The video script and storyboard imagery were shown to 30 African Americans recruited from the American Lung Association, whose reactions and comments guided further revisions. The final version was pilot tested in three diverse community settings in Chicago to determine the efficacy of Asthma 1-2-3 at improving patient understanding of asthma and its symptoms. In all, 130 adults participated in the pilot test. Knowledge scores significantly improved from pretest to posttest following presentation of the developed tool for subjects across all literacy levels (Pretest: Mean = 4.2 [SD = 1.6]; Posttest: M = 6.8 [SD = 2.0], P < 0.001). Symptom pathophysiology concepts were the least understood. Individuals with low literacy had less total knowledge score gains compared to those with marginal and adequate literacy (1.8, 2.6, and 3.2 respectively; P = 0.002). The multimedia tool significantly improved understanding of asthma. Individuals with limited literacy may require additional instruction, repeated viewing, or added tangible cues (i.e. supplementary print materials) to support knowledge retention. In general, feedback from the target population was particularly helpful in the development of the tool and its initial evaluation, and should be considered as a necessary step in the creation of other patient education materials.

Keywords

Asthma Education Knowledge Multimedia Health literacy 

Notes

Acknowledgements

This research was supported by a Centers for Disease Control and Prevention Career Development Award (Wolf: K01 EH000067-01). Authors acknowledge Quinn M. Stephens for his technical assistance.

References

  1. 1.
    Boudreaux, E. D., Emond, S. D., Clark, S., & Camargo, C. A., Jr. (2003). Acute asthma among adults presenting to the emergency department: The role of race/ethnicity and socioeconomic status. Chest, 124(3), 803–812.PubMedCrossRefGoogle Scholar
  2. 2.
    Grant, E. N., Lyttle, S. C., & Weiss, K. B. (2000). The relationship to socioeconomic factors and racial/ethnic differences in US asthma mortality. American Journal of Public Health, 90(12), 1923–1925.PubMedCrossRefGoogle Scholar
  3. 3.
    U.S. Department of Health and Human Services. (2006). Health data for all ages (HDAA): Asthma and chronic obstructive pulmonary disease, all ages: US, 1998–2006 (Source: NHIS). Retrieved March 24, 2008, from http://205.207.175.93/HDAA/TableViewer/tableView.aspx?ReportId=261
  4. 4.
    Gazmararian, J. A., Williams, M. W., Baker, D. W., & Peel, J. (2003). Health literacy and patient knowledge of chronic disease. Patient Education and Counseling, 51(3), 267–275.PubMedCrossRefGoogle Scholar
  5. 5.
    Williams, M. V., Baker, D. W., Honig, E. G., Lee, T. M., & Nowlan, A. (1998). Inadequate literacy is a barrier to asthma knowledge and self-care. Chest, 114(4), 1008–1015.PubMedCrossRefGoogle Scholar
  6. 6.
    Wolf, M. S., Davis, T. C., Arozullah, A., Penn, R., Arnold, C., Sugar, M., et al. (2005). Relation between literacy and HIV treatment knowledge among patients on HAART regimens. AIDS Care, 17(7), 863–873.PubMedGoogle Scholar
  7. 7.
    Davis, T. C., Williams, M. V., Marin, E., Parker, R. M., & Glass, J. (2002). Health literacy and cancer communication. CA: A Cancer Journal for Clinicians, 52(3), 134–149.CrossRefGoogle Scholar
  8. 8.
    U.S. Department of Education, National Center for Education Statistics. (2006). The health literacy of America’s adults: Results from the 2003 National assessment of adult literacy. Washington D.C.: Kutner M, Greenberg, E., JinY., & Paulsen, C. NCES Publication No. 2006–483.Google Scholar
  9. 9.
    Wolf, M. S., Knight, S. J., Lyons, A., Durazo-Arzivu, R., Pickard, S. A., Arseve, A., et al. (2006). Literacy, race, and PSA level among low income men newly diagnosed with prostate cancer. Urology, 68(1), 89–93.PubMedCrossRefGoogle Scholar
  10. 10.
    Sentell, T. L., & Halpin, H. A. (2006). Importance of adult literacy in understanding health disparities. Journal of General Internal Medicine, 21(8), 862–866.PubMedCrossRefGoogle Scholar
  11. 11.
    Osborn, C. Y., Paasche-Orlow, M. K., Davis, T. C., & Wolf, M. S. (2007). Health literacy: An overlooked factor in understanding HIV health disparities. American Journal of Preventive Medicine, 33(5), 374–378.PubMedCrossRefGoogle Scholar
  12. 12.
    Krishna, S., Francisco, B. D., Balas, E. A., Konig, P., Graff, G. R., & Madsen, R. W. (2003). Randomized trial. Internet-enabled interactive multimedia asthma education program: A randomized trial. Pediatrics, 111(3), 503–510.PubMedCrossRefGoogle Scholar
  13. 13.
    McPherson, A., Forster, D., Glazebrook, C., & Smyth, A. (2002). The asthma files: Evaluation of a multimedia package for children’s asthma education. Paediatric Nursing, 14(2), 32–35.PubMedGoogle Scholar
  14. 14.
    Bartholomew, L. K., Gold, R. S., Parcel, G. S., Czyzewski, D. I., Sockrider, M. M., Fernandez, M., et al. (2000). Watch, discover, think, and act: Evaluation of computer-assisted instruction to improve asthma self-management in inner city children. Patient Education and Counseling, 39(2–3), 269–280.PubMedCrossRefGoogle Scholar
  15. 15.
    Seligman, H. K., Wallace, A. S., DeWalt, D. A., Schillinger, D., Arnold, C. L., Shilliday, B. B., et al. (2007). Facilitating behavior change with low literacy patient education materials. American Journal of Health Behavior, 31(Supp 1), S69–S78.PubMedGoogle Scholar
  16. 16.
    Doak, C. C., Doak, L. G., & Root, J. H. (1996). Teaching patients with low literacy skills (2nd ed.). Philadelphia: Lippincott.Google Scholar
  17. 17.
    National Cancer Institute. (1995). Clear & simple: Developing effective print materials for low literate readers. Washington, DC: HHS. NIH Publication No. 95-3594.Google Scholar
  18. 18.
    Lavie, N., Hirst, A., de Fockert, J. W., & Viding, E. (2004). Load theory of selective attention and cognitive control. Journal of Experimental Psychology: General, 133(3), 339–354.CrossRefGoogle Scholar
  19. 19.
    van den Broek, P., & Kremer, K. (2000). The mind in action: What it means to comprehend. In B. Taylor, P. van den Broek, & M. Graves (Eds.), Reading for meaning (pp. 1–31). New York: Teacher’s College Press.Google Scholar
  20. 20.
    Rapp, D. N., & van den Broek, P. (2005). Dynamic text comprehension: An integrative view of reading. Current Directions in Psychological Science, 14, 276–279.CrossRefGoogle Scholar
  21. 21.
    Kintsch, W., & van Dijk, T. A. (1978). Toward a model of text comprehension and production. Psychological Review, 85(5), 363–394.CrossRefGoogle Scholar
  22. 22.
    Morrow, D., & Leirer, V. O. (1999). Designing medication instructions for older adults. In D. C. Park, R. W. Morrel, & K. Shifren (Eds.), Processing of medical information in aging patients. Cognitive and human factors perspectives (pp. 249–266). Mahwah, MJ: Lawrence Erlbaum Associates Publishers.Google Scholar
  23. 23.
    Paasche-Orlow, M. K., Cheng, D. M., Palepu, A., Meli, S., Faber, V., & Samet, J. H. (2006). Health literacy, antiretroviral adherence, and HIV-RNA suppression: A longitudinal perspective. Journal of General Internal Medicine, 21(8), 835–840.PubMedCrossRefGoogle Scholar
  24. 24.
    Chandler, P., & Sweller, J. (1991). Cognitive load theory and the format of instruction. Cognition and Instruction, 8(4), 293–332.CrossRefGoogle Scholar
  25. 25.
    Sweller, J. (2005). Implications of cognitive load theory for multimedia learning. In R. E. Mayer (Ed.), The Cambridge handbook of multimedia learning (pp. 19–30). New York: Cambridge University Press.Google Scholar
  26. 26.
    Kalyuga, S., Chandler, P., & Sweller, J. (2004). When redundant on-screen text in multimedia technical instruction can interfere with learning. Human Factors, 46(3), 567–581.PubMedCrossRefGoogle Scholar
  27. 27.
    Schoo, A. M. M., Morris, M. E., & Bui, Q. M. (2005). The effects of mode of exercise instruction on compliance with a home exercise program in older adults with osteoarthritis. Physiotherapy, 91(2), 79–86.CrossRefGoogle Scholar
  28. 28.
    Lavie, N. (2005). Distracted and confused?: Selective attention under load. Trends in Cognitive Sciences, 9(2), 75–82.PubMedCrossRefGoogle Scholar
  29. 29.
    Tabbers, H. K., Martens, R. L., & van Merrienboer, J. J. (2004). Multimedia instructions and cognitive load theory: Effects of modality and cueing. British Journal of Educational Psychology, 74(1), 71–81.PubMedCrossRefGoogle Scholar
  30. 30.
    Davis, T. C., Long, S. W., Jackson, R. H., Mayeaux, E. J., George, R. B., Murphy, P. W., et al. (1993). Rapid estimate of adult literacy in medicine: A shortened screening instrument. Family Medicine, 25, 391–395.PubMedGoogle Scholar
  31. 31.
    Parker, R. M., Baker, D. W., Williams, M. V., & Nurss, J. R. (1995). The test of functional health literacy in adults: A new instrument for measuring patients’ literacy skills. Journal of General Internal Medicine, 10(10), 537–541.PubMedCrossRefGoogle Scholar
  32. 32.
    Mayer, R. E. (2005). Cognitive theory of multimedia learning. In R. E. Mayer (Ed.), The Cambridge handbook of multimedia learning (pp. 31–48). New York: Cambridge University Press.Google Scholar
  33. 33.
    Pignone, M., Harris, R., & Kinsinger, L. (2000). Videotape-based decision aid for colon cancer screening. A randomized, controlled trial. Annals of Internal Medicine, 133, 761–769.PubMedGoogle Scholar
  34. 34.
    Morgan, M. W., Deber, R. B., Llewellyn-Thomas, H. A., Gladstone, P., Cusimano, R. J., O’Rourke, K., et al. (2000). Randomized controlled trial of an interactive videodisc decision aid for patients with ischemic heart disease. Journal of General Internal Medicine, 15(10), 685–693.PubMedCrossRefGoogle Scholar
  35. 35.
    Bader, J. L., & Strickman-Stein, N. (2003). Evaluation of new multimedia formats for cancer communications. Journal of Medical Internet Research, 5(3), 16–19.CrossRefGoogle Scholar
  36. 36.
    Meade, C. D., McKinney, P. W., & Barnas, G. P. (1994). Educating patients with limited literacy skills: The effectiveness of print and videotaped materials about colon cancer. American Journal of Public Health, 84(1), 119–121.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Rina M. Sobel
    • 1
  • Michael K. Paasche-Orlow
    • 3
  • Katherine R. Waite
    • 1
  • Sarah S. Rittner
    • 2
  • Elizabeth A. H. Wilson
    • 1
  • Michael S. Wolf
    • 1
  1. 1.Health Literacy and Learning Program, Center for Communication in Healthcare, Institute for Healthcare Studies, Division of General Internal MedicineNorthwestern University Feinberg School of MedicineChicagoUSA
  2. 2.Center for Healthcare Equity, Institute for Healthcare StudiesNorthwestern University Feinberg School of MedicineChicagoUSA
  3. 3.Department of Medicine, Section of General Internal MedicineBoston University School of MedicineBostonUSA

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